<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content animated fadeInRight">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<input id="parentDrugDepId" name="parentDrugDepId" type="hidden"
								th:value="${pId}">
							<input id="areaCode" name="areaCode" type="hidden">
							<div class="form-group">
								<label class="col-sm-3 control-label">上级菜单：</label>
								<div class="col-sm-8">
									<input id="" name="" class="form-control" type="text"
										th:value="${pName}" readonly>
								</div>
							</div>
							<input id="areaCode" name="areaCode" type="hidden">
							<input id="areaName" name="areaName" type="hidden">
							<div class="form-group">
								<label class="col-sm-3 control-label">药监部门代码：</label>
								<div class="col-sm-8">
									<input id="drugDepCode" name="drugDepCode" class="form-control" type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">药监部门名称：</label>
								<div class="col-sm-8">
									<input id="drugDepName" name="drugDepName" class="form-control" type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">部门全称：</label>
								<div class="col-sm-8">
									<input id="fullName" name="fullName" class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">省：</label>
								<div class="col-sm-8">
									<select class="form-control" name="province" id="Province">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">市：</label>
								<div class="col-sm-8">
									<select class="form-control" name="city" id="City">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">县/区：</label>
								<div class="col-sm-8">
									<select class="form-control" name="village" id="Village">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">状态:</label>
								<div class="col-sm-8">
									<label class="radio-inline"> <input type="radio"
										name="flag" value="1" /> 是
									</label> <label class="radio-inline"> <input type="radio"
										name="flag" value="0" /> 否
									</label>
								</div>
							</div>

							<div class="form-group">
								<div class="col-sm-8 col-sm-offset-3">
									<button type="submit" class="btn btn-primary">提交</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
		</div>
	</div>
	<div th:include="include::footer"></div>
	<script src="/js/appjs/drugadministration/department/add.js"></script>
</body>

</html>
